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J. Thorac. Cardiovasc. Surg. · Aug 2024
CSU-ALS Certified Centers are Associated with Improved Failure to Rescue After Cardiac Arrest: A Propensity Score Match Analysis.
- Matthew P Weber, Raymond J Strobel, Anthony V Norman, Abhinav Kareddy, Andrew Young, Steven Young, El MohebMohamadMDivision of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va., Sean W W Noona, Alexander M Wisniewski, Mohammed Quader, Michael Mazzeffi, Leora T Yarboro, and Nicholas R Teman.
- Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va.
- J. Thorac. Cardiovasc. Surg. 2024 Aug 22.
ObjectiveThe impact of Cardiac Surgical Unit-Advanced Life Support (CSU-ALS) training on failure to rescue after cardiac arrest (FTR-CA) is unknown. We hypothesized that institutional CSU-ALS certification would be associated with lower FTR-CA.MethodsPatients undergoing Society of Thoracic Surgeons index operations from 2020 to 2023 from a regional collaborative were analyzed. Each institution was surveyed regarding its status as a CSU-ALS-certified center. Patients stratified by CSU-ALS certification were 1:1 propensity score matched with subsequent multivariable model reviewing associations with FTR-CA.ResultsA total of 12,209 patients were included in the study period across 15 institutions. Eight centers reported CSU-ALS certification. After propensity score matching, 2 patient cohorts were formed (n = 3557). Patients at CSU-ALS centers had greater rates of intensive care unit readmission (3.9% vs 2.3%, P < .01) and total operating room time (340 minutes vs 323 minutes, P < .01). Hospital readmission was less likely in the CSU-ALS centers (9.0% vs 10.1%, P < .01). There was no difference in the rate of postoperative cardiac arrest (1.8% vs 2.2%, P = .24) or operative mortality (2.5% vs 2.9%, P = .30). After risk adjustment, CSU-ALS centers (odds ratio, 0.30; 95% confidence interval, 0.12-0.72, P < .01) and greater-volume centers (odds ratio, 0.15; confidence interval, 0.03-0.74, P = .02) had reduced odds of FTR-CA.ConclusionsCenters with CSU-ALS certification are associated with a lower risk-adjusted likelihood of FTR-CA. This highlights the importance of well-trained staff and treatment algorithms in the care of patients postcardiac surgery.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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